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Heart failure is diagnosed based on the medical and family histories, physical exam, blood test and other diagnostic procedures.No system of diagnostic criteria has been agreed as the gold standard for heart failure. Commonly used systems are the “Framingham criteria” (derived from the Framingham Heart Study), the “Boston criteria”, the “Duke criteria”, and (in the setting of acute myocardial infarction) the “Killip class”.

Echocardiography is commonly used to support a clinical diagnosis of heart failure. This modality uses ultrasound to determine the stroke volume (SV, the amount of blood in the heart that exits the ventricles with each beat), the end-diastolic volume (EDV, the total amount of blood at the end of diastole), and the SV in proportion to the EDV, a value known as the ejection fraction (EF). In pediatrics, the shortening fraction is the preferred measure of systolic function. Normally, the EF should be between 50% and 70%; in systolic heart failure, it drops below 40%. Echocardiography can also identify valvular heart disease and assess the state of the pericardium (the connective tissue sac surrounding the heart). Echocardiography may also aid in deciding what treatments will help the patient, such as medication, insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy. Echocardiography can also help determine if acute myocardial ischemia is the precipitating cause, and may manifest as regional wall motion abnormalities on echo.

Heart Failure Tests and Diagnosis:

1.Chest x ray
2.Echocardiography
3.Electrocardiogram
4.Stethoscope
5.Physical examination

Chest X-Ray:X-ray images help your doctor see the condition of your lungs and heart. In heart failure, your heart may appear enlarged and fluid buildup may be visible in your lungs. Your doctor can also use an X-ray to diagnose conditions other than heart failure that may explain your signs and symptoms.

Electrocardiogram (ECG):This test records the electrical activity of your heart through electrodes attached to your skin. Impulses are recorded as waves and displayed on a monitor or printed on paper. This test helps your doctor diagnose heart rhythm problems and damage to your heart from a heart attack that may be underlying heart failure.

Echocardiogram:An important test for diagnosing and monitoring heart failure is the echocardiogram. An echocardiogram also helps distinguish systolic heart failure from diastolic heart failure, in which the heart is stiff and can’t fill properly. An echocardiogram uses sound waves to produce a video image of your heart. This image can help doctors determine how well your heart is pumping by measuring the percentage of blood pumped out of your heart’s main pumping chamber (the left ventricle) with each heartbeat. This measurement is called the ejection fraction. The echocardiogram can also look for valve problems or evidence of previous heart attacks, as well as some unusual causes of heart failure.

Cardiac Computerized Tomography:Cardiac Computerized Tomography (CT) or magnetic resonance imaging (MRI). These tests can be used to diagnose heart problems, including causes of heart failure. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest.

In a cardiac MRI, you lie on a table inside a long tube-like machine that produces a magnetic field. The magnetic field aligns atomic particles in some of your cells. When radio waves are broadcast toward these aligned particles, they produce signals that vary according to the type of tissue they are. The signals create images of your heart.

Ejection fraction:Your ejection fraction is measured during an echocardiogram. An ejection fraction is an important measurement of how well your heart is pumping and is used to help classify heart failure and guide treatment. In a healthy heart, the ejection fraction is about 55 percent — meaning that over half of the blood that fills the ventricle is pumped out with each beat.

Coronary catheterization (angiogram):In this test, a thin, flexible tube (catheter) is inserted into a blood vessel at your groin or arm and guided through the aorta into your coronary arteries. A dye injected through the catheter makes the arteries supplying your heart visible on an X-ray. This test helps doctors identify narrowed arteries to your heart (coronary artery disease) that can be a cause of heart failure. The test may include a ventriculogram — a procedure to determine the strength of the heart’s main pumping chamber (left ventricle) and the health of the heart valves.

Stress test:Stress tests measure how your heart and blood vessels respond to exertion. You may walk on a treadmill or pedal a stationary bike while attached to an ECG machine. Or you may receive a drug intravenously that stimulates your heart similar to exercise. Stress tests help doctors see if you have coronary artery disease. Stress tests also determine how well your body is responding to your heart’s decreased pumping effectiveness and can help guide long-term treatment decisions. If your doctor also wants to see images of your heart while you’re exercising, he or she may order a nuclear stress test, which is similar to an exercise stress test, but also uses an injected dye and special imaging techniques.

Blood tests:Your doctor may take a sample of your blood to check your kidney and thyroid function and to look for indicators of other diseases that affect the heart. A blood test to check for a chemical called brain natriuretic peptide (BNP) can help check the pressure in your heart and help in diagnosing heart failure.

Medical and Family Histories

Your doctor will ask whether you or others in your family have or have had a disease or condition that can cause heart failure.

Your doctor also will ask about your symptoms. He or she will want to know which signs and symptoms you have, when they occur, how long you’ve had them, and how severe they are. Your answers will help show whether your symptoms limit your daily routine, and, if so, how much.
Physical Exam

During the physical exam, your doctor will:

1.Look for swelling in your ankles, feet, legs, abdomen, and the veins in your neck
2.Listen to your lungs for the sounds of extra fluid buildup
3.Listen to your heart for sounds that aren’t normal

Diagnostic Tests:No single test can diagnose heart failure. If you have signs and symptoms of heart failure, your doctor may recommend one or more of the following tests. He or she also may refer you to a cardiologist. A cardiologist is a doctor who specializes in diagnosing and treating heart diseases and conditions.

To diagnose heart failure, your doctor will take a careful medical history and perform a physical examination. Your doctor will also check for the presence of risk factors such as high blood pressure. Using a stethoscope, your doctor can listen to your lungs for signs of congestion. The stethoscope also picks up abnormal heart sounds that may suggest heart failure. The doctor may examine the veins in your neck and check for fluid buildup in your abdomen and legs.